| NPI | 1982695383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-007196) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 224364) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2015-04-26 |